ZINC SULFATE HEPTAHYDRATE, CUPRIC SULFATE, MANGANESE SULFATE, SELENIOUS ACID

Clinical safety rating: caution

Comprehensive clinical and safety monograph for ZINC SULFATE HEPTAHYDRATE, CUPRIC SULFATE, MANGANESE SULFATE, SELENIOUS ACID (ZINC SULFATE HEPTAHYDRATE, CUPRIC SULFATE, MANGANESE SULFATE, SELENIOUS ACID).

How it works

Zinc sulfate heptahydrate: Cofactor for numerous enzymes, essential for DNA synthesis, cell division, and immune function. Cupric sulfate: Component of cytochrome c oxidase and superoxide dismutase, involved in iron metabolism and antioxidant defense. Manganese sulfate: Cofactor for arginase, superoxide dismutase, and other enzymes; involved in bone formation and glucose metabolism. Selenious acid: Incorporated into selenoproteins (e.g., glutathione peroxidases) that protect against oxidative damage.

What the body does with it

Metabolism	Zinc: Excreted primarily in feces; minimal hepatic metabolism. Copper: Excreted mainly via bile; some metabolism by superoxide dismutase. Manganese: Excreted via bile; no significant metabolism. Selenium: Metabolized to selenide, then methylated to selenoamino acids and excreted in urine.
Excretion	Zinc: ~90% fecal (via pancreatic and biliary secretions), ~10% renal; Copper: ~80% biliary/fecal, ~20% renal; Manganese: ~98% biliary/fecal, ~2% renal; Selenium: ~60% renal (as selenite/selenate), ~40% fecal (as selenoproteins).
Half-life	Zinc: ~6-12 hours (rapid initial phase) with terminal half-life ~2-4 weeks from bone and muscle stores; Copper: ~12-24 hours for plasma, whole body ~5-10 days; Manganese: ~10-42 hours (whole body); Selenium: ~11 days (selenite) to ~66 days (selenoproteins).
Protein binding	Zinc: ~98% bound (albumin, α2-macroglobulin, transferrin); Copper: ~90-95% bound (ceruloplasmin, albumin); Manganese: ~80% bound (albumin, β1-globulin, manganese-binding proteins); Selenium: ~50-70% bound (selenoprotein P, albumin, glutathione peroxidase).
Volume of Distribution	Zinc: ~0.1-0.3 L/kg (primarily intracellular and bone); Copper: ~0.1-0.2 L/kg (liver, brain); Manganese: ~1-2 L/kg (mitochondria-rich tissues); Selenium: ~0.3-0.6 L/kg (whole body, accumulates in kidney, liver).
Bioavailability	Oral: Zinc sulfate ~20-30% (fasted); Copper sulfate ~30-40%; Manganese sulfate ~5-15%; Selenious acid ~50-80% (as selenite).
Onset of Action	Oral: Zinc, copper, manganese, selenium: 1-2 weeks for measurable changes in serum levels; IV: Immediate for serum levels, clinical effects (e.g., enzyme function) within days.
Duration of Action	Zinc: weeks to months (depends on stores); Copper: weeks; Manganese: weeks; Selenium: weeks to months. Duration reflects replenishment of body stores and normalization of dependent enzymes.

Classification & Brands

Dosing & administration

Adult: 1 mL (containing zinc sulfate heptahydrate 2.5 mg, cupric sulfate 1 mg, manganese sulfate 0.5 mg, selenious acid 60 mcg) added to TPN or IV fluids, administered intravenously once daily.

Dosage form	INJECTION
Renal impairment	Contraindicated in severe renal impairment (GFR <30 mL/min) due to risk of trace element accumulation; for GFR 30-60 mL/min, reduce dose by 50% or monitor serum levels; no adjustment needed for GFR >60 mL/min.
Liver impairment	Child-Pugh Class A: No adjustment; Child-Pugh Class B: Reduce dose by 50%; Child-Pugh Class C: Discontinue or use with extreme caution, monitor serum levels.
Pediatric use	Children: 0.2 mL/kg/day (not to exceed adult dose) added to TPN or IV fluids, administered intravenously once daily; for preterm infants, 0.15 mL/kg/day.
Geriatric use	No specific adjustment required, but monitor renal function due to age-related decline; consider starting at lower end of dosing range and titrate based on serum trace element levels.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Breastfeeding	Excreted into breast milk; considered compatible with breastfeeding at recommended doses. M/P ratio not established.
Teratogenic Risk	First trimester: No known teratogenicity at recommended doses. Second/third trimester: Essential for fetal development; deficiency may cause congenital malformations. High doses may be toxic.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to any component; Wilson disease (copper overload); hemochromatosis (iron overload, but cautious with copper); severe cholestasis or liver failure (risk of manganese accumulation)

Clinical Precautions

Precautions

Monitor serum trace element levels to avoid toxicity; copper and selenium can accumulate in cholestasis; manganese toxicity risk in liver dysfunction; allergic reactions possible; use with caution in renal impairment.

Clinical Tips & Counseling

Drug interactions

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